CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABOO2

Cervical Cancer Screening - Reimbursement and Coding Criteria

Reimbursement and coding criteria for cervical cancer screening services provided to individuals with a cervix under BCBSNM products; affects providers submitting claims to Blue Cross and Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCervical Cancer Screening - Reimbursement and Coding Criteria

Policy CodePolicy CPCPLABOO2

Change TypeAdded code(s) and terminology update

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be requested to provide additional documentation; claims are subject to review.

SourceLink

POLICY UPDATE CHANGES

Added new CPT code 87626 effective 01/01/2025.

Document updated with literature review and code 0502U added; references updated.

Terminology changed from 'Women' to 'individuals' throughout reimbursement information.

3 yrsHPV testing interval

18+Annual screening eligible

Not reimb.Post-hysterectomy

87623-87626Example codes

v1.0Version/approval

Cervical Cancer Screening Reimbursement Criteria

Cervical cancer screening reimbursement criteria

Reimbursement criteria for cervical cancer screening (applies to individuals with a cervix):

ALL of the following

ALL of the following
- Annual cervical cancer screening may be reimbursable for individuals 18 years of age and older
ALL of the following
- HPV testing may be reimbursable once every three (3) years for individuals aged 30 and older
  Applies to individuals with a cervix aged 30+
ALL of the following

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyCervical Cancer Screening - Reimbursement and Coding Criteria

Policy CodePolicy CPCPLABOO2

Change TypeAdded code(s) and terminology update

Effective DateJan 15, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be requested to provide additional documentation; claims are subject to review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure and Billing Codes

Example HPV and cytology codesCPT

87623	HPV test (example listed)
87624	HPV test (example listed)
87625	HPV test (example listed)
87626	Newly added HPV code effective 01/01/2025
88141	Cervical cytology code (example listed)
88142	Cervical cytology code (example listed)
88143	Cervical cytology code (example listed)
88147	Cervical cytology code (example listed)
88148	Cervical cytology code (example listed)
88150	Cervical cytology code (example listed)

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HPV testing interval

HPV testing intervalHPV testing may be reimbursable once every three (3) years for individuals aged 30 and older.

Age applicabilityApplies to individuals aged 30 years and older.

Relation to cytologyThis interval is specified separately from annual cytologic screening; see reimbursement criteria for combined approaches.

Documentation and Claim Review

Documentation Required

Documentation, coding and claim-review requirements

Providers must submit accurate documentation of services performed and code claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Claims are subject to code edit protocols and review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; upon request, providers should submit any additional documentation.

Use valid code combinations from HIPAA-approved code sets and follow Uniform Billing, CPT, HCPCS, ICD-10-CM/PCS, and other industry coding guidance.
Be prepared to provide additional documentation upon request to support medical necessity, coding, or eligibility.
Claims are subject to code edit protocols, CCI edits, and claim review against plan documents and policy rules.